CDSS for Tobacco Screening and Follow-up Documentation 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN SRCH hired a consultant to: a) build out the preventive medicine section in our EHR to make the tobacco screening and follow-up documentation more visible, and b) delete areas where staff documented tobacco screening and counseling in the past. We trained clinical staff to document in the preventive medicine location in January 2017. Additionally, QI staff updated and rolled out tobacco screening CDSS alerts in March 2017. Alerts notify clinical staff when a patient is overdue on tobacco screenings. Since SRCH’s QI and EHR teams were working so closely, SRCH decided to develop an “EHR Optimization Team” and hired a designated trainer to train new clinical staff. As staff started to screen more frequently and encountered patients with the desire to quit smoking, clinical staff began using MI techniques to set action plans and providing those patients with encouragement cards to stop smoking. SRCH uses 1 800-NO-BUTTS resources. SRCH’s tobacco screening and follow-up for PHASE program reporting (UDS definition) was 51% in 2015 Q3 and increased to 75% as of 2017 Q2. This improvement was a result of EHR optimizations and implementing CDSS alerts in eCW. SRCH’s Interventions Workgroup decided in mid-2016 to standardize documentation to preventive medicine and removed documentation locations in HPI and social history. SRCH invested in building out their preventive medicine section so tobacco screening and follow-up documentation was visible, they deleted all other locations and provided training for staff in January 2017. In just a couple of quarters after implementation of CDSS, SRCH’s tobacco screening and cessation counseling significantly improved. AIM WORKFLOW To improve tobacco screening and follow-up documentation for Santa Rosa Community Health (SRCH) patients ages 18 and up. Patient comes in for visit *More detailed workflow available in attachment Provider assesses patient for tobacco use EHR alert notifies provider that patient is overdue for tobacco screening MEASURES Measure: Tobacco Screening & Follow-Up Numerator: Patients who had a tobacco assessment within two years prior to their last medical visit If the patient was a tobacco user in the past two years, the patient had at least one of the following within two years prior to their last medical visit: Tobacco use cessation counseling Smoking cessation agents (active medication or order) Denominator: 18 years of age or older during the reporting period and seen after their 18th birthday Had at least two medical visits or at least one preventive visit during the reporting period Patient screens negative for tobacco use Patient screens positive for tobacco use Provider discusses results with patient No immediate action required Rescreen at next visit Provider offers cessation intervention(s) (counseling, medication, etc.) Follow-up documented in preventive medicine. RESULTS TO DATE SRCH’s tobacco screening and follow-up for PHASE program reporting (UDS definition) was 51% in 2015 Q3 and increased to 75% as of 2017 Q2. CDSS Alert Screenshot: LESSONS LEARNED Tobacco screenings and counseling were being completed prior to 2017 but were not always documented in the proper locations and not captured in reporting. The improved preventive medicine section of our EHR and deletion of all other locations where staff documented tobacco screening and follow-up combined with staff training and new CDSS alerts facilitated improved systems and outcomes for this measure. The creation of a new EHR Optimization Team at SRCH is making these improvements sustainable through ongoing trainings and expertise to continue optimizations and CDSS maintenance.

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]

PROMISING PRACTICE OVERVIEW [Title] 2017 Symposium on the Future of Complex Care Gallery of Promising Practices PROMISING PRACTICE OVERVIEW ACTIONS TAKEN [CONTENT] [CONTENT] AIM WORKFLOW [CONTENT] [BASIC FLOWCHART] MEASURES [CONTENT] RESULTS TO DATE [CONTENT] Image Title/Chart Title/Etc. [INSERT IMAGE HERE] LESSONS LEARNED [CONTENT]